The following article is a response to the position paper of the Hastings Center, "Ethical Challenges of Chronic Illness", a product of their three year project on Ethics and Chronic Care. The authors of this paper, three prominent bioethicists, Daniel Callahan, Arthur Caplan, and Bruce Jennings, argue that there should be a different ethic for acute and chronic care. In pressing this distinction they provide philosophical grounds for limiting medical care for the elderly and chronically ill. We give a critical (...) survey of their position and reject it as well as any attempt to characterize the physician-patient relationship as a commercial contract. We emphasize, as central features of good medical practice, a commitment to be the patient's agent and a determination to acquire and be guided by knowledge. These commitments may sometimes conflict with efforts to have the physician serve as an instrument of social and economic policies limiting medical care. Keywords: acute, agent, autonomy, chronic, knowledge, obligations, rights CiteULike Connotea Del.icio.us What's this? (shrink)

Medicine needs our trust. We need to be able to rely on individual clinicians and researchers, and we need to be able to have confidence in hospitals and clinics. Yet the organization of our healthcare institutions is not designed to promote that trust. In fact, the structure of our medical institutions seems to undermine our faith.

As early as 1981 Gorlin and Zucker produced a film, AComplicatingFactor:Doctors'FeelingsasaFactorinMedicalCare and in a 1983 paper on the subject they described one of the important epiphenomena of the encounter between doctor and patient—namely, the reaction of the physician to the patient and how this affects both the physician and the quality of the relationship. At that time they were concerned with the physicians' ability to reckon with their own reactions to patients who presented with problems or personality traits that complicated (...) the doctor-patient relationship. Some patients were hateful or unlikable, some denied their disease state, some became unusually dependent on the physician, some were intimidating to the doctor. Their behavior evoked responses that tended to complicate the doctor-patient relationship with distancing, unusual identification, or hostility. That publication recognized and explained the problem and went on to suggest a process of achieving emotional awareness and mastery to help physicians maintain their appropriate role. (shrink)

ABSTRACT While interest in philosophy and medicine has burgeoned in the past two decades, there remains a need for an analysis of the intellectual activity embodied in good medical practice. In this setting, ethical and scientific decision‐making are complexly interrelated. The following paper, collaboratively written by physicians and philosophers, presents a view of applied (clinical) science and applied ethics. Making extensive use of illustrations drawn from routine case material, we seek to indicate a variety of philosophic issues to be found (...) in daily practice, elucidate various levels of critical reasoning within the medical setting, and demonstrate a remarkable similarity between medical and ethical decision‐making. (shrink)

Comparative environmental philosophy is valuable in many ways. Perhaps it is most valuable because it reveals some of the foundational assumptions that run so deep in the poles of comparison that they might otherwise have gone unnoticed. These revelations may invite us to challenge those assumptions that have led to the kind of thinking responsible for much of the environmental degradation that we see today. Japanese Environmental Philosophy gathers papers focused on the environmental problems of the twenty-first century. Drawing from (...) Japanese philosophical traditions they investigate our relationships with other humans, nonhuman animals, and the environment. The heart of the book consists of chapters written by fifteen top scholars from Japan, the United States, Europe, and Australia. The essays cover a broad range of topics drawn from various strains of Japanese thought—including Zen Buddhism, Shintoism, the Kyoto school, and Japanese philosophy of art and aesthetics—as well as from traditional Japanese culture and the contemporary science of planning for natural disasters. These articles demonstrate that Japanese scientific, philosophical, religious, and cultural traditions can provide meaningful insight to address the current global environmental crisis. (shrink)

This essay challenges the dominance of the spherical earth model in fifteenth- and early-sixteenth-century Western European thought. It examines parallel strains of Latin and vernacular writing that cast doubt on the existence of the southern hemisphere. Three factors shaped the alternate accounts of the earth as a plane and disk put forward by these sources: the unsettling effects of maritime expansion on scientific thought; the revival of interest in early Christian criticism of the spherical earth; and a rigid empirical stance (...) toward entities too large to observe in their entirety, including the earth. Criticism of the spherical earth model faded in the decades after Magellan’s crew returned from circuiting the earth in 1522. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial (...) known as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

A woman's right to know the contents of her own body, and to make a choice about whether to continue her pregnancy or not, should be defended against laws trying to stop prenatal sex selection, either in the developing world or in the developed world. Restrictions on women's reproductive freedom harm the interests of women and girls, and ignore myriad social policy solutions, such as education and income incentives to have girls and universal old age pensions, that provide better answers (...) to the strains of unbalanced sex ratios. The opponents of sex selection trumpet all accounts of increased discrimination against women resulting from unequal sex ratios while ignoring growing evidence of positive cultural change and women's empowerment fromwomen's enhanced marriage prospects. Opponents of sex selection reify a conservative heteronormative model of sexuality, gender roles and family structure, while arguing that unmarried men are social time bombs who can only be controlled by a wife. Eventually the social policy dilemma around sex selection will presumably be made moot since would-be parents will be able to use pre-conceptive technology to determine a conceptus's gender without abortion or in-vitro fertilization. But until the sex selection argument unravels before technological innovation, women's rights to control their bodies must be defended against laws banning - or requiring - prenatal ultrasound and abortion. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial (...) known as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

Through a number of studies recently published in the psychology literature, T.D. Wilson, D.T. Gilbert, and others have demonstrated that our judgments about what our future mental states will be are contaminated by various distortions. Their studies distinguish a variety of different distortions, but they refer to them all with the generic term “affective forecasting.” The findings of their studies on normal volunteers are remarkably robust and, therefore, demonstrate that we are all vulnerable to the distortions of affective forecasting. a.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Selected Letters by William, Henry JamesWilliam James EarleWilliam and Henry James. Selected Letters. Edited by Ignas K. Skrupskelis and Elizabeth M. Berkeley. Introduction by John J. McDermott. Charlottesville VA: University Press of Virginia, 1997. Pp. xxxi + 570. $ 39.95.Almost fifty years of letters to and from the very diversely brilliant James brothers: in this volume a generous, and probably ample, selection of 216 from (...) a total of 740 surviving letters or postcards, from an original total, according to the present editors, of twice as many. This volume of correspondence reflects the deep, unquestioned, unshakable familial (and virtually statutory) closeness of William and Henry who happened, as adults, to be seldom in the same place. There is, it must be said, very little explicit philosophy, narrowly or broadly defined, in these letters, but the philosophical reader will—or ought to—find much raw material for philosophical reflection. For example, a reasonable historicist thesis of how brotherhood, or family connection generally, plays itself out is supported by these documents. The nineteenth century is not the same as the twentieth. For example, here is William’s comment on the will of his sister, Alice, who left more to her companion and care-giver, Katherine Loring, a [End Page 479] women of extraordinary virtue and burden, than to her brother Robertson: “I can well sympathize with Alice’s desire to leave her something handsome; but I must say that her own consent (being apparently privy to the will) strikes me as tant soit peu lacking in delicacy. Surely no one of us would like to be in such a position in her family or any other” (271). This would be, in 1998, a rather unenlightened and ungenerous attitude, but is natural enough in 1892, even if not quite inevitable, not being shared by Alice herself. There is, incidentally, much discussion of wills and bequests, for the Jameses were of the genteel class, people with small family money and modest private incomes for whom the wherewithal to maintain homes with servants and to provide themselves with country houses and recuperative European vacations was always a faintly embarrassing, and occasionally a pressing, problem.It is probably also true that the much-discussed question of Henry’s homosexuality has, somehow, to be recast in historically relative terms. Here is an early report—1869—of Henry’s from Oxford: “As I walked along the river I saw hundreds of the mighty lads of England, clad in white flannel & blue, immense, fair-haired, magnificent in their youth, lounging down the stream in their punts or pulling in straining crews & rejoicing in their godlike strength” (41). This could not, the point is, be said by anyone, gay or straight, in 1998. Yet Henry is neither generally naive nor uncritically anglophile. He says of the Warwickshire scenery, which in a way he likes, that it is “too monotonously sweet & smooth—too comfortable, too ovine, too bovine, too English in a word.” And he adds, a little surprisingly: “It seems like a vast show region kept up at the expense of the poor” (41). This is only one of many appealing comments not sparsely scattered, but unpredictably, in letters of more ordinary news. Here’s one I liked occasioned by seeing theater in Paris: “We talk about it & write about it & criticize & dogmatize & analyse to the end of time: but those brave players stand forth & exemplify it & act—create—produce!” (66).Of course the “wit and wisdom” are not the monopoly of Henry. Here is William being wise: “We all learn sooner or later that we must gather ourselves up and more or less arbitrarily concentrate our interests, throw much overboard to save any” (55–56). Again: “It is a sweet world, in the interstices of its bedevilment & brutality” (321). And William being funny: “Boils are surely the most slowly evolving things in nature—Christian doctrine is nothing to them” (393). He is talking about his own boils and was subject, at every period, to ailments and infirmities: “Since writing to you, I have been swimming in deep seas of influenza, gout and Erysipelas of the face” (443). Or as he, in 1900, sums it up: “My... (shrink)

Global cycles of rising and declining hegemonies within the world-system have been associated with periods of war and peace, free trade and protectionism, and economic expansion and contraction. Periods of hegemonic decline are also associated with the cultural production of a certain strain of self deprecating, or even self-hating, literary output. And, because we are dealing with the world-system, the popularity of such icons of national self-deprecation should be gappreciated within other countries. We see this in the fact that (...) Don Quixote, poking fun at Spanish chivalry was an immensely popular book outside as well as inside Spain. Similarly, the James Bond books, and particularly the movies had a huge audience world wide, and, the same could be said for the Rambo movies which poked fun at the chivalric Green Beret American military figure. We see, then, three instances of hegemonic decline—Spain, Britain, United States—and three instances of self-deprecating literary figures—Don Quixote, James Bond, and Rambo. (shrink)

In this paper, we explore Peirce's work for insights into a theory of learning and cognition for education. Our focus for this exploration is Peirce's paper The Fixation of Belief (FOB), originally published in 1877 in Popular Science Monthly. We begin by examining Peirce's assertion that the study of logic is essential for understanding thought and reasoning. We explicate Peirce's view of the nature of reasoning itself—the characteristic guiding principles or ‘habits of mind’ that underlie acts of inference, the dimensions (...) of and interaction between doubt and belief, and his four methods of resolving or ‘fixing’ belief (i.e., tenacity, authority, a priori, and experimentation). The four methods are then juxtaposed against current models of teaching and learning such as constructivism, schema theory, situated cognition, and inquiry learning. Finally, we discuss Peirce's modes of inference as they relate educationally to the resolution of doubt and beliefs and offer an example of belief resolution from an experienced teacher in a professional development environment. (shrink)

This study compares college students with other adults in terms of the Muncy–Vitell (1992) consumer ethics scale. Further, the study updates the Muncy–Vitell consumer ethics scale with modifications that include rewording and the addition of new items. These new items can be grouped into three distinct categories – (1) downloading/buying counterfeit goods, (2) recycling/environmental awareness and (3) doing the right thing/doing good. The study also compares these two groups in terms of their attitude toward business. Results show that there is (...) indeed a significant difference between these two groups in terms of ethical perceptions, but not in terms of the “recycling” items and the “doing good” items. There was also little difference between the groups in terms of their attitude toward business indicating that attitude toward business does not explain their different ethical perspectives. (shrink)

It is now well-known that Newton–Cartan theory is the correct geometrical setting for modelling the quantum Hall effect. In addition, in recent years edge modes for the Newton–Cartan quantum Hall effect have been derived. However, the existence of these edge modes has, as of yet, been derived using only orthodox methodologies involving the breaking of gauge-invariance; it would be preferable to derive the existence of such edge modes in a gauge-invariant manner. In this article, we employ recent work by Donnelly (...) and Freidel in order to accomplish exactly this task. Our results agree with known physics, but afford greater conceptual insight into the existence of these edge modes: in particular, they connect them to subtle aspects of Newton–Cartan geometry and pave the way for further applications of Newton–Cartan theory in condensed matter physics. (shrink)

We argue that in contemporary business organizations, in which fundamental purpose is construed to be increased value—especially in ‘participative’ organizations, in which non–hierarchal interaction (for example, work teams) is the norm; and in ‘adaptive’ organizations, in which unpredictable change is the rule—a process of values covenanting will be much more valueable than just espoused values or even values covenants. We propose such a process model for organizational values covenanting and argue that such covenanting reflects an anthropomorphism of the human character (...) development process, validated in terms of the theory of viable systems. (shrink)

This major new book contains a collection of papers that examine the current state-of-the-art in the valuation of environmental resources. In particular, they assess the meaningfulness of environmental resource values obtained through the contingent valuation metho.

A full separation theorem for the derivable rules of intuitionistic linear logic without bounds, 0 and exponentials is proved. Several structural consequences of this theorem for subreducts of (commutative) residuated lattices are obtained. The theorem is then extended to the logic LR+ and its proof is extended to obtain the finite embeddability property for the class of square increasing residuated lattices.

Biblical Christianity should be a powerful, life-forming, paradigm-shifting experience leading to increasing levels of Christlikeness. Unfortunately, the experience of many Christians today is far short of the transformation described in Scripture. This article reports on a portion of mixed-methods research examining the transformative learning reported by alumni of a 22-lesson discipleship process called the Immersion Experience by Aphesis Group Ministries. Holistic spiritual health involves listening to our emotions, confronting toxic shame, addressing childhood defenses, and untangling our distorted spirituality.

Previous plan‐based models of dialogue understanding have been unable to account for many types of subdialogues present in naturally occurring conversations. One reason for this is that the models have not clearly differentiated between the varoius ways that an utterance can relate to a plan structure representing a topic. In this paper we present a plan‐based theory that allows a wide variety of utterance‐plan relationships. We introduce a set of discourse plans, each one corresponding to a particular way that an (...) utterance can relate to a discourse topic, and distinguish such plans from the set of plans that are actually used to model the topics. By incorporating knowledge about discourse into a plan‐based framework, we can account for a wide variety of subdialogues while maintaining the computational advantages of the plan‐based approach. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Dictionary of Scripture and Ethics ed. by Joel B. GreenTimothy J. SandovalDictionary of Scripture and Ethics Edited by Joel B. Green grand rapids, mi: baker academic, 2011. 912 pp. $60.00.An important addition to the scholarly literature that relates the Bible and ethics, the Dictionary of Scripture and Ethics (DSE) stands as a marker of how far that scholarly enterprise has come in the last forty years. As the (...) volume’s editor notes, if a generation ago James Gustafson lamented the paucity of efforts to link scripture and ethics, this is no longer the case in either ethics or biblical studies (1).DSE (to which I contributed one entry) is comprehensive, containing entries on a range of ethical topics and every biblical book. The volume includes an introduction delineating the organizational principles of the dictionary and three fine essays sketching the ethical shape of scripture, the history of relating scripture to ethics, and methodological issues in this endeavor. Published by a Christian press with entries betraying a mix of conservative (Catholic, evangelical) and liberal perspectives, DSE is oriented toward Christian scripture and Christian ethics. This is no criticism but an observation about DSE’s scope in relation to its title (21).In its approximately nine hundred pages, DSE contains some entries on ethical topics that barely allude to the biblical tradition while other entries on biblical material read not much differently from a standard Bible dictionary entry. Yet most articles on topics in ethics helpfully point to key biblical texts associated with the topic. Many others also deftly relate the history of thinking on an ethical issue and its biblical foundations. Most entries on the Bible likewise successfully sketch how biblical texts explore moral matters, and these articles regularly point out ethical “problems” that many biblical texts evoke for contemporary readers (e.g., concerning nationalism, violence, sexuality, and the like).Those of us in biblical studies who seek to articulate what Hans Frei called the “abiding significance” of the Bible sometimes falter in this effort, offering [End Page 222] stale, strained, or canned ideas about what passage X or Y “might mean for us today.” We falter, perhaps, because we have been deeply formed by the historical-critical study of the Bible. We thus often lack a vocabulary and logic, a different sort of discourse that does not merely translate into ethical and theological terms the exegetical findings we arrive at as classically trained biblical scholars but also engages in a quite different sort of exegetical work. In particular, the entries in DSE that treat broader topics in ethics will expose biblical scholars to different modes of relating critically to the texts than we are accustomed to. DSE will thus prove particularly useful for those of us who wish to explore and cultivate an exegetical practice as well as an identity as exegetes that is distinct from what emerges when we apply the historical and other critical tools that our training has bequeathed us (33).Ethicists can be assured that the entries on the Bible reliably sketch basic, current discussions in biblical studies although inevitably specialists will quibble over details and occasionally over broader issues—something the editor notes happens even between entries within DSE (2). As one of those quibbling specialists, I hoped to find an entry on “hermeneutics” or “biblical hermeneutics” in a volume so concerned with biblical interpretation, though a number of articles do, more or less, address such issues. I must leave it to ethicists to discern the quality and consistency of DSE entries on ethics.In short, DSE may offer only a first step for students and scholars seeking to relate scripture and ethics, but it is an important step.Timothy J. SandovalBrite Divinity SchoolCopyright © 2016 Society of Christian Ethics... (shrink)

In this chapter we consider three philosophical perspectives (including those of Stalnaker and Lewis) on the question of whether and how the principle of conditional excluded middle should figure in the logic and semantics of counterfactuals. We articulate and defend a third view that is patterned after belief revision theories offered in other areas of logic and philosophy. Unlike Lewis’ view, the belief revision perspective does not reject conditional excluded middle, and unlike Stalnaker’s, it does not embrace supervaluationism. We adduce (...) both theoretical and empirical considerations to argue that the belief revision perspective should be preferred to its alternatives. The empirical considerations are drawn from the results of four empirical studies (which we report below) of non-experts’ judgments about counterfactuals and conditional excluded middle. (shrink)

Business and marketing ethics have come to the forefront in recent years. While consumers have been surveyed regarding their perceptions of ethical business and marketing practices, research has been minimal with regard to their ethical beliefs and ideologies. This research investigates general attitudes of consumers relative to business, government and people in general, and compares these attitudes to their beliefs concerning various questionable consumer practices. The results show that consumers'' ethical beliefs are determined, in part, by who is at fault (...) in the unethical behavior (the seller or the buyer). The results also indicate that those with a more positive attitude toward business are less likely to engage in questionable consumer practices, but one''s attitudes toward salespeople, the government and people in general arenot related to the consumer''s ethical beliefs. (shrink)